Holding vs Continuing GLP-1/GIP Agonists Before Upper Endoscopy: The OCULUS Randomized Clinical Trial

By
Akram I. Ahmad
Samita Garg
Jeffrey Jacobs
Zaid Ansari
Tasneem Jamal Al-Din
Ashraf Almomani
Sara Valencia
John Vargo
Arjun Chatterjee
Hassan Siddiki
Liang Hong
Michael A. Nicolas
Alaina Miller
Tilak Shah
May 1, 2026
0 min

Jama Internal Medicine

Overview

The OCULUS trial evaluated the impact of continuing versus holding GLP-1/GIP agonists before upper endoscopy. Results indicated that continuing these medications led to a higher rate of clinically significant residual gastric volume, yet no aspiration events occurred.

Background

GLP-1 and GIP agonists are increasingly used for managing type 2 diabetes and related conditions, with their effects on gastric emptying raising concerns during sedation for procedures like endoscopy. Current guidelines recommend holding these medications before procedures, but evidence supporting this practice is limited. The OCULUS trial aims to provide high-quality data to inform clinical decision-making regarding the management of these medications in the perioperative setting.

Data Highlights

Outcome	Continue Group	Hold Group
Clinically Significant Residual Gastric Volume	25%	3%

Key Findings

Continuing GLP-1/GIP agonists increased clinically significant residual gastric volume compared to holding one dose.
Approximately 25% of patients in the continue group had significant residual volume versus 3% in the hold group.
No aspiration or escalation events occurred during the trial.
Symptom screening was ineffective in predicting retained gastric contents.
No primary-outcome events were observed when upper endoscopy was paired with colonoscopy after a clear-liquid diet.

Clinical Implications

Clinicians should consider the findings of the OCULUS trial when making decisions about GLP-1/GIP agonist management prior to endoscopic procedures. Individualized patient assessment may be necessary, particularly in light of the potential for increased residual gastric volume with continued medication use.

Conclusion

The OCULUS trial provides important insights into the management of GLP-1/GIP agonists before upper endoscopy, suggesting that continuing these medications may not pose significant risks of aspiration, but could lead to increased residual gastric volume.